title: Voxelwise assessment of the regional distribution of damage in the brains of patients with multiple sclerosis and fatigue.
abstract: OBJECTIVE
  Fatigue affects up to 90% of patients with MS. We assessed the regional distribution of lesions and atrophy of the normal-appearing WM and GM in patients with RRMS with fatigue compared with HC and patients with similar characteristics, but without fatigue.
  
  
  METHODS
  From 14 patients with RRMS without fatigue, 10 with RRMS with fatigue, and 14 HC, we acquired brain dual-echo and high-resolution T1-weighted scans. Voxel-wise distributions of GM, WM damage, and T2 lesions were compared between patients with fatigued and nonfatigued MS by using SPM5 software. We report results at P < .05, FWE corrected.
  
  
  RESULTS
  T2 lesion distribution and regional WM atrophy did not differ between patients with fatigued and nonfatigued MS. Compared with HC, patients with MS had significant WM atrophy in the posterior part of the corpus callosum and significant GM atrophy of the left superior frontal sulcus, left precentral gyrus, posterior cingulate cortex, right thalamus, and left middle frontal gyrus. No additional areas of atrophy were found in patients with nonfatigued MS compared with HC, whereas patients with fatigued MS also had atrophy of the left central sulcus. Atrophy in the left central sulcus and the precentral gyrus was more severe in patients with fatigued versus nonfatigued MS. In patients with MS, significant correlations were found between fatigue severity and GM atrophy in the left precentral gyrus (r = -0.73, P < .0001 uncorrected).
  
  
  CONCLUSIONS
  Atrophy of the primary sensorimotor area is likely to contribute to MS-related fatigue.
authors.affiliation: Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Riccitelli
authors.forename: M A
authors.initials: MA
authors.lastname: Rocca
authors.forename: C
authors.initials: C
authors.lastname: Forn
authors.forename: B
authors.initials: B
authors.lastname: Colombo
authors.forename: G
authors.initials: G
authors.lastname: Comi
authors.forename: M
authors.initials: M
authors.lastname: Filippi
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D017352:Echo-Planar Imaging / Q000379:methods*; D005221:Fatigue / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis*; D012680:Sensitivity and Specificity